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K..A. Lee

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    MINI 36 - Imaging and Diagnostic Workup (ID 163)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Screening and Early Detection
    • Presentations: 1
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      MINI36.12 - Diagnosis of Peripheral Lung Nodules: Cost Analysis of EMB/EBUS Compared to TTNB (ID 254)

      18:30 - 20:00  |  Author(s): K..A. Lee

      • Abstract
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      This analysis compares the cost–effectiveness of radial endobronchial ultrasound (EBUS) and electromagnetic navigation (ENB) to transthoracic needle biopsy (TTNB) to achieve diagnosis of suspicious lung lesions. As more centers develop lung screening and lung nodule clinics, there will be a need for diagnosis of small pulmonary nodules. The National Lung Screening Trial (NLST) showed a probable positive Low Dose Computer Tomography (LDCT) incidence of 25%, indicating the number of patients requiring a diagnostic evaluation will increase. The expectation of increased lung cancer screening due to the Centers of Medicare and Medicaid Services approving coverage for LDCT for eligeable patients, and the American College of Chest Physicians (ACCP) recommendation for improved techniques to diagnose peripheral lung lesions necessitate utilizing clinical and economic assessment tools that support clinical decisions. The study seeks to identify the most cost-effective biopsy protocol to reduce costs, and deliver improved diagnostic accuracy.

      The study reviewed the NLST which enrolled over 50,000 people aged 55–74 years with at least a 30-pack/year smoking history, in fairly good health and non-symptomatic of lung disease. The study found low-dose computed tomography of the chest resulted in a 20% lower mortality from lung cancer compared with those who had chest x-rays. Approximately 25% of the LDCT-screened patients had a positive screen requiring confirmation of the lung lesion. Using an estimate of 5.2 million annual chests CT scans in the USA as a basis for the number of patients seeking a confirmative result before being recommended for surgery for possible benign lung lesions. The cost–effectiveness models employed estimate the direct costs to the hospital and to the patient. Direct costs were calculated using the Medicare Median cost files by Current Procedural Terminology (CPT) code for 2012. Additional costs were added to account for the fee of the procedure room, nursing and clinical support staff, and observation room time. Reimbursement reflects the 2013 Medicare allowable payment exclusive of the geographic adjustment factor. Reimbursement from commercial insurers is constructed upon a conservative multiple of the Medicare allowable. CPT codes subject to the multiple procedure discounts were properly reduced by 50% as they would be for reimbursement purposes for both Medicare and commercial insurance reimbursement.

      Modeling 200 representative patients delegated to; TTNB, bronchoscopy, or R-EBUS-/ENB-enabled endobronchial percutaneous (Endo-Perc) when comparing procedure fees, insurance payment and clinical outcomes, the Endo-Perc technique lead to the most cost-effective option to biopsy the lung lesion. The lower adverse event profile of pneumothorax and reduced cost exhibited by the Endo-Perc procedure; resulted in a benefit of $130,464 compared with a loss of $562,863 for TTNB, or a loss of $103,487 for routine bronchoscopy.

      The results suggest combining R-EBUS with ENB provides a high-diagnostic yield at a lower cost due to the lower risk of a pneumothorax when compared with transthoracic lung biopsy.

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